Members of Congress and the news media have a bad habit of referring to efforts to stop Medicare from arbitrarily cutting payments to physicians for taking care of their patients as the “Doc Fix.” Typical is this story from CNN—“Bipartisan Love: Boehner, Pelosi strike deal to kick doc fix”—that reported on the release yesterday of an agreement between the two leaders on a bill to repeal the Medicare SGR formula, which I also covered in my blog post yesterday.
Calling SGR repeal the “Doc Fix” creates the impression that it’s a self-serving bill to benefit an influential group at the expense of others. (Think about how’d you react if you read that a bill was an “oil company fix” or "tobacco industry fix”—you’d suspect the rest of us were being taken for a ride, which would probably be true).
Saying it’s a “Doc fix” makes the issue unnecessarily polarizing, because it implies that if Congress votes for permanent SGR repeal, it’s putting doctors ahead of a more deserving group, like kids covered under the Children’s Health Insurance Program, when both are about improving access for patients, old and young. (SGR repeal has become linked to CHIP, because the House leadership agreement permanently repeals the SGR, while it reauthorizes CHIP for just two more years, when many Senate Democrats want at least four years for CHIP).
Let me give you two reasons why the House leadership’s SGR repeal bill, summarized here, really is about fixing Medicare to make it work better for patients, not about fixing things to provide some unfair benefit to doctors:
1. It will improve access for patients enrolled in Medicare. If the scheduled 21% SGR cut were to go into effect on April 1 as scheduled, there is no doubt that many (most?) physicians could no longer afford to see Medicare patients; patients would begin to lose their doctors and would have great trouble finding new ones, as is the case today for many Medicaid enrollees. Even if Congress decided to temporarily override the cut by freezing current rates for several more months, as it has done so many times before, physicians wouldn’t know what to expect when the patch again expires; such instability is causing many physicians to reassess how many Medicare patients they can see. Plus, even with the temporary SGR overrides, Medicare payments have not kept pace with inflation for at least 13 years now—which in itself has caused some physicians to reassess their participation in the program. For example, I know of a highly respected internist in Montana, a long time reader of this blog, who made the painful decision a few years ago to discontinue seeing any Medicare patients, because Medicare payments hadn’t covered his costs for years. As long as we have the SGR formula, patches or no patches, the more we will see good physicians join this good Montana doctor in discontinuing or limiting participation in Medicare.
2. It will create incentives for physicians to provide higher quality, cost-effective and accessible care to patients. It’s this aspect of the House’s SGR bill that has gotten the least attention from the news media and members of Congress themselves, when it is what the bill is mostly about, creating a better physician payment system. In fact, the part of the SGR bill that repeals the SGR formula, and replaces the 21% cut from it with small positive updates over the next five years, is only 5 pages out of a 158 page bill! What’s in the other 153 pages?
- Payment incentives for physicians who are able to demonstrate that they have made changes in their practices to benefit patients, like becoming Patient-Centered Medical Homes, a model that has been shown to improve quality and patient satisfaction and lower costs.
- Payment incentives for physicians who achieve better clinical outcomes, for using health information technology effectively, and for delivering care more effectively and efficiently without sacrificing quality.
- Harmonizing and prioritizing measures to reduce the burden of reporting on physicians (accomplished by consolidating three existing Medicare reporting programs, each with their own measures, deadlines, penalties and incentives, into a single new Merit-based Incentive Program).
- A new option for physicians to earn even higher Medicare payments for participating in Alternative Payment Models (APM), like Accountable Care Organizations and advanced PCMHs, and for the medical profession to propose new models.
- More dedicated federal funding to develop good measures of quality, patient satisfaction and cost.
- And a new, federally funded program to help smaller practices.
These and other reforms made by the bill are all about changing Medicare payment policies to support greater value—quality, effectiveness, efficiency—to patients, the Medicare program, and to taxpayers who pay for it, and to support physicians who are willing to do their part to help achieve greater value for their patients. So yeah, you could say that the fix is in, but the fix is to make Medicare a better program for the patients enrolled in it, by changing the way that doctors are paid, not a “doc fix” implying an unfair sweet deal for doctors.
Today’s question: “Doc Fix” or fixing Medicare to make it better for patients, what do you think the bill really does?